Potentiation of Rocuronium Bromide by Lithium Carbonate: A Case Report

Lithium carbonate is a medication used for the management of various mental disorders. The present report describes a case of prolongation of rocuronium bromide in a patient concurrently taking lithium carbonate. A 64-year-old woman was scheduled to undergo cystectomy under general anesthesia. The patient took lithium carbonate (600 mg/d) for treatment of bipolar affective disorder. General anesthesia was induced with propofol, fentanyl, remifentanil, and sevoflurane. After loss of consciousness, rocuronium bromide (50 mg) was administered, and the trachea was intubated. Approximately 1 hour after the administration of rocuronium, the degree of residual muscle relaxant was evaluated using a nerve stimulation device. No muscle contraction occurred with train-of-four (TOF) stimulation. Following administration of sugammadex (200 mg) the TOF ratio increased to 95%. The ionic size of lithium is similar to that of sodium; therefore, lithium is transported into the cell with sodium. The resting membrane potential decreases, leading to a reduction in the height of the action potential. Thus, the effect of the remaining lithium may have been superimposed on the rocuronium neuromuscular blockade. Evaluation with a nerve stimulation device in patients taking lithium is crucial before extubation because of the risk of rocuronium potentiation.

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Optical Stimulation of Thalamic Spindle Circuitry Sustains Electroencephalogram Patterns of General Anesthesia but not Duration of Loss of Consciousness

Neuroscience ◽

10.1016/j.neuroscience.2021.06.009 ◽

2021 ◽

Author(s):

Lia Mesbah-Oskui ◽

Patrick Gurges ◽

Wen-Ying Liu ◽

Richard L. Horner

Keyword(s):

General Anesthesia ◽

Loss Of Consciousness ◽

Optical Stimulation ◽

Stimulation Of

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Identification of the General Anesthesia Induced Loss of Consciousness by EEG Spectrum Analysis

International Journal of Psychophysiology ◽

10.1016/j.ijpsycho.2021.07.604 ◽

2021 ◽

Vol 168 ◽

pp. S224-S225

Author(s):

Yuqin Li ◽

Fali Li ◽

Lin Jiang ◽

Dezhong Yao ◽

Tao Xu ◽

...

Keyword(s):

General Anesthesia ◽

Spectrum Analysis ◽

Loss Of Consciousness ◽

Eeg Spectrum

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Recognition of general anesthesia-induced loss of consciousness based on the spatial pattern of the brain networks

Journal of Neural Engineering ◽

10.1088/1741-2552/ac27fc ◽

2021 ◽

Author(s):

Yuqin Li ◽

Fali Li ◽

Hui Zheng ◽

Lin Jiang ◽

Yueheng Peng ◽

...

Keyword(s):

Spatial Pattern ◽

General Anesthesia ◽

Brain Networks ◽

Loss Of Consciousness ◽

The Brain

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Nuclear Receptor Rev-Erb-α Circadian Gene Variants and Lithium Carbonate Prophylaxis in Bipolar Affective Disorder

Journal of Biological Rhythms ◽

10.1177/0748730410362713 ◽

2010 ◽

Vol 25 (2) ◽

pp. 132-137 ◽

Cited By ~ 41

Author(s):

Sara Campos-de-Sousa ◽

Camila Guindalini ◽

Leonardo Tondo ◽

Janet Munro ◽

Sarah Osborne ◽

...

Keyword(s):

Affective Disorder ◽

Nuclear Receptor ◽

Bipolar Affective Disorder ◽

Lithium Carbonate ◽

Gene Variants ◽

Circadian Gene

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Influence of Spinal and General Anesthesia on Newborn’s Status

Macedonian Medical Review ◽

10.1515/mmr-2015-0014 ◽

2015 ◽

Vol 69 (2) ◽

pp. 65-70

Author(s):

Emilija Ivanov ◽

Dafina Karadzova ◽

Sotir Nikolovski ◽

Atanas Sivevski ◽

Kiro Curlinov ◽

...

Keyword(s):

Caesarean Section ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Apgar Score ◽

Base Excess ◽

Rocuronium Bromide ◽

Apgar Scores ◽

Ph Values ◽

Vital Parameters

AbstractIntroduction. The number of caesarean sections has drastically increased and thus arose the idea to examine the effect of the type of anesthesia on the neonates. The objective was to compare vital parameters in the neonates, born under general and spinal anesthesia.Method. A total of 120 patients with need for caesarean section have been divided in two groups of 60, of which the first was lead in general and the second one in spinal anesthesia. The first one was given propophol (2.0-2.5 mg/kg/tt) and succinil colin (1-1.5 mg/kg/tt). The anesthesia was lead with fentanil 0,005 mg/kg/tt and rocuronium bromide 0.4-0.6 mg/kg/tt. O2:N2O was 3:3 l/min. The second group was lead in spinal anesthesia. 2-3 ml Bupivacain 0.5% was spinally applied between L2-L3. Apgar score was defined in the neonates in the first and fifth minutes. The acido-basic status of the neonate was examined through pH values in the blood and the base excess.Results. In the first minute after birth giving with Apgar, 8 newborns 37(61,67%) were born to the group of patients with SA and 29 (48.33%) to the group of patients with GA. In 11 (18.33%) newborns born to the patients led with SA had Apgar score of 9-10, while only 3 (5%) of the newborns born to the patients led with GA had Apgar score of 9-10. Similar ratio was noted in the fifth minute after birth. Ph of the newborns’ blood as well as the base excess (BE) demonstrated significantly lower values in the group of patients led with SA than in the group of patients led with GA. Ph = 7.33 vs 7.37; BE=-4.57±1.8 vs -2.96±2.3.Conclusion. The newborns from the second group had significantly higher Apgar scores than those in the first group. The newborns’ relative acidose (lower SpO2and BE) did not affect the newborns’ Apgar score in the first and fifth minute.

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Effects of COX 1-2 Inhibitors on Prevention of Rocuronium Injection Pain: Controlled, Randomised, Double Blind Study

10.22541/au.161646222.24501995/v1 ◽

2021 ◽

Author(s):

Mehmet Sahap ◽

Handan Gulec ◽

Esra ozayar ◽

Ozlem zdemir ◽

Merve Kacan ◽

...

Keyword(s):

General Anesthesia ◽

Control Group ◽

Anesthesia Induction ◽

Movement Response ◽

Rocuronium Bromide ◽

Cox Inhibitors ◽

Significant Difference ◽

Group 2 ◽

Withdrawal Response ◽

Group 1

Purpose : Rocuronium bromide is a painful agent while general anesthesia induction. The aim of the study is to investigate the effects of cox inhibitors as a resque agent against the rocuronium pain Methodology : Sixty patients enrolled for the general anesthesia enrolled in this study. Patients were allocated into two groups (Group 1: Dexkethoprofen group, Group 2: Control group) .Pain was evaluated by during rocuronium injection, patients were scored by a scale showed below. 0;No movement response to injection 1;Mild movement response to injection 2;Hand withdrawal response to injection 3;Arm withdrawal response to injection We also evaluated the pain with 2 questions when the patient was in the recovery room.Question 1.What was the last feeling before you fall into sleep? and question 2. Did you feel any pain on your hand during medication injection for anesthesia? Results:There were differences between the groups in terms of total pain score for example in group 1 there were 16 (53%) patients who did not make any movement during rocuronium injection while there were 22 (73%) patients in group 2.There was significant difference in injection rocuronium bromide pain between group 1: dexkethoprofen group, Group 2: control group in terms of the answer to the second question.Patients felt less pain than the control group. Conclusion:The effect of cox inhibitors on rocuronium pain was seen in our study but check is also effective in reducing pain in vascular width.

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The Effect of Glycopyrrolate on Induction Dose of Propofol during General Anesthesia

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1146 ◽

2015 ◽

Vol 49 (2) ◽

pp. 62-65

Author(s):

Suman Arora ◽

Harihar Vishwanath Hegde ◽

Jyotsna Wig

Keyword(s):

Heart Rate ◽

Cardiac Output ◽

General Anesthesia ◽

Significant Positive Correlation ◽

Saline Group ◽

Small Extent ◽

Loss Of Consciousness ◽

Test Drug ◽

Normal Saline Group ◽

Induction Dose

ABSTRACT Background Preinduction cardiac output (CO) is a small but significant predictor of induction dose of propofol. We hypothesized that glycopyrrolate, by inducing tachycardia (although to a small extent) would increase CO, and hence the induction dose of propofol. Aim of the study was to find out the dose of propofol required to induce anesthesia in patients receiving glycopyrrolate as compared to those not receiving it. Meterials and methods Eighty female patients (25-60 years, ASA-1, 2) undergoing elective procedures under general anesthesia were randomized into group G (glycopyrrolate) and group C (control). Patients received 1 ml (0.2 mg) glycopyrrolate (group G) or 1 ml normal saline (group C) intravenously 5 minutes before induction. Anesthesia was induced with propofol at a rate of 0.8 mg/kg/min titrated to achieve a target BIS = 40. Dose of propofol required for induction of anesthesia (loss of consciousness) and to reach the target BIS, heart rate (HR) and mean arterial pressure (MAP) at various intervals were compared. Correlation between the dose of propofol required to reach target BIS = 40 and heart rate after giving the test drug was performed by regression analysis. Results The dose of propofol required for achieving target BIS was significantly higher (p < 0.001) in group G (2.08 ± 0.42 mg/kg) (mean ± SD) as compared to group C (1.66 ± 0.23 mg/ kg). There was a significant positive correlation between the preinduction HR (3 minutes after giving the test drug) and the propofol dose required to reach target BIS = 40 (r = 0.356, p < 0.01). Conclusion Administration of 0.2 mg of glycopyrrolate intravenously before induction of general anesthesia significantly increased the dose of propofol required for induction of anesthesia. How to cite this article Arora S, Hegde HV, wig J, Puri GD. The Effect of Glycopyrrolate on Induction Dose of Propofol during General Anesthesia. J Postgrad Med Edu Res 2015;49(2): 62-65.

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Lithium-Induced Downbeat Nystagmus and Horizontal Gaze Palsy

The Open Ophthalmology Journal ◽

10.2174/1874364101610010126 ◽

2016 ◽

Vol 10 (1) ◽

pp. 126-128 ◽

Cited By ~ 8

Author(s):

Jesper Skovlund Jørgensen ◽

Lisbeth Landschoff Lassen ◽

Marianne Wegener

Keyword(s):

Affective Disorder ◽

Therapeutic Range ◽

Bipolar Affective Disorder ◽

Lithium Carbonate ◽

Downbeat Nystagmus ◽

Ocular Motility ◽

Horizontal Gaze ◽

Gaze Palsy

We report a case of lithium-induced downbeat nystagmus and horizontal gaze palsy in a 62-year-old woman who was treated for a bipolar affective disorder with lithium carbonate for one month. At presentation serum lithium was within therapeutic range. No alternative causes of the ocular motility disturbances were found, and the patient improved significantly as lithium carbonate was discontinued.

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Propofol Requirement in Patients with Growth Hormone-Secreting Pituitary Tumors Undergoing Transsphenoidal Surgery

Journal of Clinical Medicine ◽

10.3390/jcm8050571 ◽

2019 ◽

Vol 8 (5) ◽

pp. 571

Author(s):

Seung Hyun Kim ◽

Namo Kim ◽

Eui Hyun Kim ◽

Sungmin Suh ◽

Seung Ho Choi

Keyword(s):

Growth Hormone ◽

General Anesthesia ◽

Transsphenoidal Surgery ◽

Pituitary Tumors ◽

Aminobutyric Acid ◽

Loss Of Consciousness ◽

Gamma Aminobutyric Acid ◽

Gh Secretion ◽

Effect Site ◽

Effect Site Concentration

Growth hormone (GH) secretion is regulated by various hormones or neurotransmitters, including gamma-aminobutyric acid. The aim of this study was to determine the propofol requirement in patients with GH-secreting pituitary tumors undergoing transsphenoidal surgery. General anesthesia was induced in 60 patients with GH-secreting tumors (GH group, n = 30) or nonfunctioning pituitary tumors (NF group, n = 30) using an effect-site target-controlled intravenous propofol infusion. The effect-site concentrations were recorded at both a loss of consciousness and a bispectral index (BIS) of 40, along with the effect-site concentration after extubation, during emergence from the anesthesia. The effect-site concentration of propofol was higher in the GH group than in the NF group at a loss of consciousness and a BIS of 40 (4.09 ± 0.81 vs. 3.58 ± 0.67, p = 0.009 and 6.23 ± 1.29 vs. 5.50 ± 1.13, p = 0.025, respectively) and immediately after extubation (1.60 ± 0.27 vs. 1.40 ± 0.41, p = 0.046). The total doses of propofol and remifentanil during anesthesia were comparable between the groups (127.56 ± 29.25 vs. 108.64 ± 43.16 µg/kg/min, p = 0.052 and 6.67 ± 2.89 vs. 7.05 ± 1.96 µg/kg/h, p = 0.550, respectively). The propofol requirement for the induction of a loss of consciousness and the achievement of a BIS of 40 is increased during the induction of general anesthesia in patients with GH-secreting tumors.

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